scholarly journals Why do patients with minor complaints choose emergency departments and does satisfaction with primary care services influence their decisions?

2017 ◽  
Vol 19 (04) ◽  
pp. 398-406 ◽  
Author(s):  
Yakup Akpinar ◽  
Hakan Demirci ◽  
Ersin Budak ◽  
Ayse Karalar Baran ◽  
Ali Candar ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Emergency Departments ◽  
Emergency Services ◽  
Family Doctor ◽  
Working Hours ◽  
Family Doctors ◽  
Care Services ◽  
Primary Care Services ◽  
First Contact

AimTo identify the reasons why patients with minor complaints choose emergency departments (EDs) as a first contact of care and whether dissatisfaction with primary care services influences their decisions.MethodsIn this study, a self-completed survey called EUROPEP was given to 535 outpatients who were admitted to the XXXXX Hospital in Bursa and examined in the green zone in July 2015. Patients were asked about their complaints and why they preferred EDs as a first contact of care.ResultsEDs were the first contact of care in 87.8% of cases. In all, 9% of patients registered to family physicians who were working outside the city of Bursa. There was no relationship between patient satisfaction and the number of previous visits to EDs in last 12 months (P=0.09). The main reasons for admitting to the emergency services were feeling excessive pain (20.4%), perception of urgency (14.5%) and that the family doctor services were closed outside working hours (13.2%). The mean patient satisfaction with family practice offices was calculated to be 68.1%.ConclusionsThe frequency of admission to EDs as a first contact of care was extremely high in the absence of a referral system. Patients who did not have family doctors in the settlement where they live put an extra burden on the EDs. Overall, patient satisfaction with their GPs did not influence the number of visits to EDs but accessibility remains a big challenge.

scholarly journals Primary care services co-located with Emergency Departments across a UK region: early views on their development

2017 ◽  
Vol 34 (10) ◽  
pp. 672-676 ◽  
Author(s):  
Suzanne Ablard ◽  
Colin O’Keeffe ◽  
Shammi Ramlakhan ◽  
Suzanne M Mason
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Services ◽  
Primary Care Services

scholarly journals Learning from diagnostic error when primary care services are located in or alongside emergency departments: a theory generating mixed-methods study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703277
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Niro Siriwardena ◽  
Adrian Edwards
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Emergency Departments ◽  
Care Service ◽  
Diagnostic Error ◽  
Learning System ◽  
Care Staff ◽  
Care Services ◽  
Primary Care Services ◽  
Service Models

BackgroundNew healthcare service models are being introduced to help manage increasing demand on emergency healthcare systems including the provision of primary care services in or alongside emergency departments. There is little research evidence to guide decisions about how service models can be most effective and safe.AimFocusing on diagnostic error, the aim was to learn why errors occur to identify priority interventions.MethodTwo data sources were used to identify diagnostic error reports including: coroners’ reports to prevent future deaths; and the National Reporting and Learning System (NRLS). A cross-sectional, mixed-methods theory-generating study which used a multi-axial PISA classification system based on the recursive model for incident analysis, was carried out.ResultsNine Coroners’ reports (from a total of 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error with learning relevant to primary care services in or alongside emergency departments. Clinical presentations included musculoskeletal injuries; unwell infants; headaches; and chest pains. Findings highlighted a difficulty identifying appropriate patients for the primary care service; underinvestigation; misinterpretation of diagnostic tests; underuse of safeguarding protocols; and inadequate communication and referral pathways between the services.ConclusionPriority areas to minimise risk of diagnostic error when primary care services are located in or alongside emergency departments include clinical decision support to triage and stream patients to the appropriate care setting; contextualised, workplace-based education and training for primary care staff; and standardised computer systems, communication and referral pathways between emergency and primary care services.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

FACTORS ASSOCIATED WITH THE ASSESSMENT ON HEALTH CARE QUALITY AT COMMUNE HEALTH CENTERS IN THUA THIEN HUE PROVINCE

2017 ◽  
pp. 53-61
Author(s):  
Minh Tam Nguyen ◽  
Thi Hoa Nguyen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Satisfaction ◽  
Health Status ◽  
Care Quality ◽  
Health Care Facilities ◽  
Health Centers ◽  
Important Indicator ◽  
Care Services ◽  
Primary Care Services

Background: Patient satisfaction is an important indicator of healthcare quality. Better satisfaction is associated with greater adherence to treatment and better health outcomes. Primary care is considered the basic structure of many healthcare systems. Evaluation of healthcare provision is essential in the ongoing assessment and consequent quality improvement of healthcare services. Objective: To describe and analyze the determinants associated with patient assessment and satisfaction in primary care. Methods: The survey was conducted with 519 households and 209 patients at 18 commune health centers. The questionnaire included sociodemographic variables, health status, and use and satisfaction with primary care services. We undertook descriptive analyses, bivariate correlations to study the relationship between levels of satisfaction and the explanatory variables for demographics, health status and health services for households and patients. Results: The majority of households and patients were satisfied with the health care services at primary health care facilities. Satisfaction of waiting time, communication and counseling by healthcare providers was high. We found significant associations between the level of satisfaction and owning health insurance card, the first contact point assigned at CHCs, the severity of illness episodes, and health condition of participants. Conclusions: The results provide evidence on factors that should be taken into account in the planning and development of health policies with respect to the quality and delivery of primary care services in order to enhancing the satisfaction of clients. Key words: consumer satisfaction, patient satisfaction, primary care, quality indicators

scholarly journals Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper

2019 ◽  
Vol 36 (10) ◽  
pp. 625-630 ◽  
Author(s):  
Alison Cooper ◽  
Michelle Edwards ◽  
Janet Brandling ◽  
Andrew Carson-Stevens ◽  
Matthew Cooke ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Service Providers ◽  
Routine Data ◽  
Emergency Department Patient ◽  
Classification Systems ◽  
Care Services ◽  
Primary Care Services ◽  
And Function

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function—from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.

scholarly journals Patients’ Perceptions Regarding the Availability of Primary Care Services in Romania - A Pilot Survey Among Users of Primary Care Services in Braşov County

2020 ◽  
Vol 13 (62) (2) ◽  
pp. 73-84
Author(s):  
Andreea Elena Neculau ◽  
Liliana Rogozea ◽  
Daniela Popa ◽  
Ioana Atudorei ◽  
Marius Alexandru Moga ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Users ◽  
Primary Care System ◽  
Family Doctors ◽  
Pilot Survey ◽  
Care Services ◽  
Primary Care Services ◽  
Degree Of Satisfaction ◽  
The Subject ◽  
High Degree

In Romania, users’ perceptions about availability of services in primary care have not been explored since 2009, when a national report was produced, and little is therefore known about the subject. The study aims to identify perceptions of primary healthcare service users regarding the availability of services in primary care. This research is a pen-and-paper self-administered survey applied to an opportunity sample of people, addressing family doctor’s practices, from 17 selected settlements of Brasov county. Overall, the analysis of population’s perceptions on the primary care system in Brasov County shows a high degree of satisfaction among the patients despite a narrow spectrum of services offered by family doctors.

Patient satisfaction with primary care services in Lithuania

2005 ◽  
Vol 11 (1) ◽  
pp. 31-32
Author(s):  
Jonas Kairys ◽  
Egle Zebiene ◽  
Virginijus Sapoka
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Care Services ◽  
Primary Care Services

PP18 Is there provider induced demand at emergency departments with primary care services? Patient, local and wider system factors described to influence demand for primary care in emergency departments: realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A8.2-A8
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Realist Evaluation ◽  
Urgent Care ◽  
Induced Demand ◽  
Care Services ◽  
Primary Care Services ◽  
Additional Demand ◽  
System Factors ◽  
Primary Care Clinicians

BackgroundEvidence from evaluations of emergency departments (EDs) with co-located primary care services suggests that they influence additional demand for non-urgent care (provider-induced demand). In a realist review of the literature on the effects of primary care services in EDs we proposed a theory that when primary care services are distinct at an ED they may encourage additional primary care demand and when primary care clinicians work indistinctly in the ED there is no additional demand. We aimed to explore evidence for this theory and explain contexts, mechanisms and outcomes that influence such demand.MethodsWe used realist evaluation methodology and carried out observations of key processes. We interviewed 23 patients, 21 ED clinical directors, 26 other ED staff members and 26 GPs at 13 EDs (England & Wales). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to provider induced demand.ResultsEDs with distinct primary care services were perceived to attract more demand for primary care than EDs where primary care clinicians worked indistinctly because the primary care service was visible, widely known about, enabled direct access, and received NHS 111 referrals. Other influences on demand were patients’ experiences of accessing primary care, the capacity for urgent care in the community, location of the ED and public transport links, service design and developments (new buildings, renovations) and population characteristics (unfamiliarity with local healthcare services, not registered with a GP or different cultural perceptions of seeking health care).ConclusionsA range of patient, local-system and wider-system factors contribute to additional demand at an ED with co-located primary care services. Our findings can inform providers and policymakers in developing strategies to limit the effect of these influences on additional demand.

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